TIMI Risk Score for UA/NSTEMI

The TIMI (Thrombolysis in Myocardial Infarction) Risk Score is a simple, widely used clinical risk stratification tool developed to predict the risk of adverse outcomes in patients presenting with Acute Coronary Syndrome (ACS). There are two primary and distinct versions of this score, each with different parameters and scoring, as they apply to different patient populations: one for patients with Unstable Angina or Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) and another for patients with ST-Elevation Myocardial Infarction (STEMI). The version forUA/NSTEMIis the most commonly referenced and uses seven presenting variables, each worth 1 point, for a total score ranging from 0 to 7. The components are: age ≥ 65 years, presence of ≥ 3 risk factors for coronary artery disease (family history, hypertension, hypercholesterolemia, diabetes, or smoker), known coronary artery disease (stenosis ≥ 50%), aspirin use in the past 7 days (indicating more refractory disease), recent severe angina (≥ 2 episodes in last 24h), ST-segment changes ≥ 0.5 mm on admission ECG, and elevated cardiac necrosis markers (like troponin). A higher score on this scale (e.g., 5-7) correlates with a significantly increased risk of all-cause mortality, new MI, or urgent revascularization at 14 days, guiding towards more aggressive therapy (like an early invasive strategy). The version forSTEMIis used for patients undergoing thrombolysis and calculates a 30-day mortality score, with a total score from 0 to 14. Its components are more complex and weighted: age (65-74 years = 2 points; ≥ 75 years = 3 points), history of diabetes, hypertension, OR angina (1 point), systolic blood pressure < 100 mmHg (3 points), heart rate > 100 bpm (2 points), Killip class II-IV (indicating heart failure, 2 points), weight < 67 kg (1 point), anterior wall infarction or LBBB (1 point), and time to treatment > 4 hours (1 point). Both scales are crucial bedside tools to aid clinicians in rapid prognostic assessment and therapeutic decision-making.